The Surgeon Who Took On UnitedHealth Now Pays the Price

Dr. Elisabeth Potter’s viral stand against America’s largest health insurer has left her clinic financially reeling.

The high-profile dispute between Austin-based Dr. Elisabeth Potter and the nation’s largest insurer, UnitedHealth Group – which has received global media attention after Potter’s video complaint about the carrier’s business practices went viral –has left the Texas breast-reconstruction surgeon short of cash, but with zero regrets.    

Potter (no relation) says she’s lost hundreds of thousands of dollars because UnitedHealth has refused to include her RedBud Surgery Center in its insurance network, and thus endangered the survival of the clinic that she started in 2023 with a reported $5 million investment.      

But her biggest frustration – more than a half-year into the running battle – is that more physicians and other health care professionals can’t, or won’t, join her in speaking out openly about the industry practices, such as insurance claims rejections and delays, that she believes are crippling American medicine.

Dr. Elisabeth Potter (CREDITS: Dr. Elisabeth Potter)

“There is an industry that doesn't want me out there telling the truth,” Potter said recently in a telephone interview. “So that is frightening. But I am not sorry that I did it. This is just my path. This is the place that the universe has put me and is asking me, like, ‘Elisabeth, who are you?’ And so this is who I am.”      

Potter’s dispute with UnitedHealth – which blew up in January after she posted about a bizarre incident in which a representative of the massive insurer called her in the middle of an operation to question a patient’s approval to stay in the hospital overnight – is one of several recent highly publicized incidents that have cast a spotlight on business practices that boost profits but allegedly harm patients.     

But the surgeon’s running feud with the corporation – with its conflicting she-said/they-said claims over what really happened – has raised a second and also troubling question in an age where a rant on sites like TikTok or Instagram can get hundreds of thousands of views: Do doctors or nurses risk the hammer of retaliation when they criticize the business practices of health care conglomerates on social media, or elsewhere.     

Although UnitedHealth has adamantly denied it, Potter thinks she is being punished financially for speaking out, and she is not the only one. In recent years, several large states such as Florida, and the American Medical Association, have promoted legislation and other measures to protect physician whistleblowers who speak out about insurance denials or other forms of industry cost-cutting that puts patients at risk.       

I recently spoke with the manager of a large arthritis clinic in Missouri who has also claimed that her growing public reputation as a critic of Big Insurance practices, such as prior authorization rejections, is the reason why Elevance Health (formerly Anthem) abruptly dropped the facility from its network.       

Julie Baak, the office manager of the St. Louis Arthritis Center, who opened an account on Twitter, now X, in 2020 and began calling out insurance denials, said she believes her increasingly visible complaints played a role in Elevance dropping the clinic from its network this summer, prompting a scramble among as many as 900 of her patients, most of whom were not informed of the sudden change.       

Elevance said in its letter that the large Blue Cross Blue Shield affiliate is merely “modernizing” its network of approved facilities, which Baak said she doesn’t buy. She said that she “really pissed some people off at the insurance companies because they don't want to be publicly shamed. And they act.”

The potential for conflict seems inevitable. In the 2020s, the power of a small number of oversized insurance outfits, and the growing trend of physicians working for an employer such as a hospital or large clinic instead of independently, have given profit-minded executives enormous economic leverage. Yet the arrival and rapid growth of social media has given doctors or other health care workers a new outlet to complain against business practices that hurt patient care. Frontline medical workers like Potter and Baak are doing exactly that, but at what risk to their careers?     

For Potter, her frustrations with the Big Insurance and the state of American health care boiled over after her run-in with UnitedHealth that occurred in January. She was in the middle of surgery at an Austin hospital when she was told a representative of the insurance company was calling about the patient who was asleep on the operating table. Potter took the call and later said UnitedHealth was questioning “mundane details” of the patient’s case and the necessity for an overnight hospital stay, even though the surgery itself was pre-approved.

Potter filmed a video complaining about the call and posted it on TikTok, Instagram and X that same day. “Insurance is out of control,” she told the camera. “I have no other words." Coming with patient complaints about UnitedHealth already in the news, in the national conversation that was sparked by the December assassination of Brian Thompson, the CEO of the company’s insurance division, her postings were seen by millions. Many shared their own bad experiences with UnitedHealth in their comments.

UnitedHealth doesn’t dispute that the call occurred, but has insisted it wasn’t necessary for Potter to leave the operating table and answer it. More importantly, the surgeon and the insurer have sharply different versions of why her RedBud Surgery Center is not part of the UnitedHealth network. The company maintains it told Potter last fall it is no longer adding new ambulatory surgery centers, but Potter has said the center was in negotiations with UnitedHealth that abruptly stopped after posting the video.         

About a week after the posting, Potter said she received a letter from a top-flight law firm representing UnitedHealth threatening a defamation lawsuit if she did not retract her claims. However, Potter has not taken down the videos and no legal action has been filed. But Potter has said the exclusion of her clinic from the UnitedHealth network has been a huge financial hardship. She’s previously said that – with that $5 million in debt from the launching of her clinic – she’s since had to sell off assets and has used up her family’s savings in order to keep it afloat.       

In the recent interview, Potter observed that the modern structure of health care – in which doctors who a generation ago might have been independent are now employed by large hospital sysems or insurance companies – actively discourages most physicians from speaking out about the growing stresses they face. She says health care professionals are likely more reluctant to fight back against an insurer or even contest an allegation made by a nurse or other staffer out of fear of facing discipline the potential loss of hospital privileges – or even their jobs.     

“There's a subculture of, ‘You will get fired or disciplined or labeled if you speak up about insurance,’” Potter said. “ And this is for people who don't work for insurance companies. They work in hospitals. [Because] the hospitals rely on the insurance companies.” She later added that “the whole process is designed to remove the humanity from medicine and turn it into a machine.”

Indeed, the financial hit that she’s taken during her dispute with UnitedHealth is arguably a powerful example of what can potentially happen to risk-takers. Yet Potter said she believes strongly that not speaking out about the inequities in the system that harm, or potentially harm, patient care would go against the reasons she became a surgeon in the first place.   

 “I just can't go to sleep at night if I lied, or if I hurt somebody who was less able to protect themselves – if I didn't speak up for the underdog,” Potter said. “Like, I have to do those things. That’s my career that I chose because of the person I am.” 

And Potter isn’t the only one trying to speak out. Despite worries about the possible economic consequences, Baak, the office manager at the St. Louis area arthritis center, has made something of a name for herself in the last couple of years for complaining publicly about the struggles that clinics like hers face in winning approvals for insurance claims. She has not only built up a following on social media but even developed a presentation called, “How to Fight Insurance Denials.”

Now, Baak can’t help but wonder if her heightened visibility, or maybe just her long history of fighting back on claims, has something to do with the recent letter from Elevance that it’s dropping the arthritic clinic from its Anthem network. So far, Baak has pressed for more information from the giant insurer – which at the time of the letter covered a substantial 900 of the clinic’s patients – but hasn’t received much information. She also claims that most of her patients haven’t been informed of the change by Elevance, despite their short window to find new insurance – or a new doctor.   

Baak noted that rheumatology clinics “already have a big target on our backs” because of the high cost of newer medications, but she also believes her activism makes her stand out.  She imagined the insurer saying, “‘Let's take out the low-hanging fruit of this ‘nut job,’ Julie Baak, who appeals everything and doesn't follow any of the rules. It's not that I'm not following rules…I am following the rules. But what I'm not willing to do is non-medical switches, step therapy and yank these patients around.”